Health Committee on April 11th, 2016

[The Chair, Liberal, Bill Casey]

Were you saying something, Mr. ...?

[A voice]

I thought you said that time is up.

[The Chair, Liberal, Bill Casey]

Time is up, yes.

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Minister, welcome to the committee, and thank you to the officials for being with us here today. I want to start with some of the big, broad issues facing Canadian health care and I'm going to start with the health accord.

As you know, the Conservatives unilaterally imposed a 10-year health accord in 2014, with a formula that contained a 6% escalator for the first three years until 2017 and then it dropped to 3% for the remaining seven years thereafter. Your mandate letter, of course, commits you to negotiating a new agreement. I've asked the Parliamentary Budget Office to review your budget and fiscal framework and they have confirmed to me that they can't find any money budgeted, either in your budget or fiscal framework, for any increase to the escalator after 2017.

During the election your leader quite famously told Canadians that you can't have a Tommy Douglas health care system on a Stephen Harper budget.

Is your government going to increase the escalator after 2017, or are you going to adopt the Conservative's health transfer escalator funding?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Thank you for the question.

As you know, the matter of the Canada health transfer is something that I don't get to decide by myself. I will have input into that discussion, of course, as will other health ministers, but it's a decision that will fundamentally be made by finance ministers and first ministers across the country in terms of the size of the transfer. I've certainly had this discussion with my counterparts who are, of course, interested in addressing issues like the escalator, like demographic top-ups, etc.

What we have said is that there will be a long-term funding agreement. We have not yet made a commitment as to what that will be.

Second, we are committed to making sure there is transformation in the system, and I recognize that while money is not the only way to transform the system, money can ideally—and in best-case scenarios—help to buy change, and help to incent people to change. Those kinds of discussions will be a big part of those conversations with my counterparts.

On the third area of whether it shows up in the budget or not, I can tell you that we have committed to a $3-billion investment in home care. That money is going to be there. Whether it shows up in the fiscal framework at the Parliamentary Budget Office right now or not, it's a commitment we are holding to.

[Don Davies, NDP, Vancouver Kingsway, BC]

Can I move to that?

Thank you, you've foreshadowed where I'm going next because during the federal election the Liberal Party promised Canadians that a Liberal government would invest $3 billion over four years for home care. Now we're in year one of your four-year mandate and your budget doesn't have a penny allocated to home care in this year.

My first question in a two-part question is, where is the first year of home care funding?

Your leader also famously talked about back-loading promises and he appeared to object to that. I can't find a single reference, in not only the first year but in any of the years of your fiscal framework, to where that $3 billion is. Can you point to the budget or fiscal framework and show me where the $3 billion is budgeted for that commitment?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

When I talk to Canadians about the federal government transferring money to the provinces, one of the things they're very interested in is making sure that we know what that money is going to do. There is a tremendous amount of interest in the concept that if there will be new investments, how will we know where that money is going to be spent and how is it going to inform the system.

I think the option was potentially there that we could have written the $3 billion into the budget and said that we would figure out later how the money is going to be spent. I don't think that would have been responsible of us. I'm very pleased that we have not yet written it into the budget. There will be another budget next year and between now and when our budget is produced next year, that's when I need to have those important conversations with the health ministers in the provinces and territories. You can be sure I'll be holding the finance minister to helping me out with that.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. Good.

I want to move to pharmacare. Nearly a quarter of Canadian households report difficulties paying for prescription medication based on cost. Over one in 10 Canadians say they do not fill their prescriptions because they don't have the money.

Canada is the only country in the world with a universal health care system, the only one of many countries, that does not provide universal prescription coverage, and you said in your remarks, with which I agree, that in Canada folks need to get the medicine and care they need regardless of their ability to pay. That's not the case in Canada with prescription medicine now.

Your government has committed to entering the pan-Canadian pharmaceutical initiative, which entails bulk buying and a national formulary, and I applaud you for that. You'll have our support on that. But these initiatives do not result in every Canadian getting access to the medicine that they need. Are you open to implementing a national universal pharmacare system to make sure every Canadian gets the medicine they need during this term of office?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

I want to thank you for your advocacy on this matter, because it's something that I am very interested in. I've talked to others about it and I think it's terrific that you are continuing to press on this matter. If I'm not mistaken I believe that the committee is planning to look at this issue. I think that's terrific.

I really, genuinely look forward to your report and your ideas as to what pharmacare could look like in Canada. Having said that, you know that it's not part of my current mandate. What the Prime Minister has asked me to do at the moment is to work on bringing down the cost of pharmaceuticals and making sure that they are accessible and affordable for Canadians.

I think that as a responsible step this is an important first step. If we were to lock in the prices that are there now, if we were to instantly institute a universal pharmacare program, we'd be locking in extremely high-priced medications.

There are actually a number of very interesting levers, and this is something you might want to ask about after I've left as well today, because I think you might be interested in some of the things that can be done. You talked about the pan-Canadian pharmaceutical alliance, which we're delighted to have joined as a federal payer, but there's actually a lot of work that can be done, for instance, with the Patented Medicine Prices Review Board around the regulations that are associated with that, which can help to drive down costs. There's work that needs to be done on the development of a national formulary, which we currently do not have and it will take some time to develop.

All of those are steps toward...and if you as a committee can help to make the case, then that's something I think I'd be interested in talking about.

[Don Davies, NDP, Vancouver Kingsway, BC]

We'll do our best. I want to get a couple of quick questions in on Bill C-2. I know I'm running out of time. I applaud your evidence-based decision on supervised consumption sites. I come from Vancouver and there's no question that they save lives, they help stop the spread of disease, they help encourage people seeking help and assistance, and, in fact, help them in getting off drugs.

But I am puzzled by the fact that despite your positive comments you have indicated quite clearly that you are not interested in repealing Bill C-2, which every stakeholder in the country who favours supervised consumption sites says presents unnecessary barriers to opening such sites. Twenty-seven different criteria in that bill make it very difficult to open those, which I think was the entire objective of the previous government in introducing it.

Can you tell us why your government wouldn't repeal that law if you truly believe that opening these sites saves lives and we need to actually make it easier for communities to get them, not harder?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

That's a great question. This is something we are following very closely. I agree with you that it looks on first glance.... On that law there was a lot of interest in repealing it and I continue to hear from people who are interested in repealing the law.

The reality is that in order to provide an exemption for some of these supervised consumption sites, there are a number of steps that, whether that law had been put in place or not, Health Canada would have required a site to go through. They include things like making sure you've consulted with the chief of police, making sure you've consulted with other stakeholders, making sure you have safety mechanisms for surveillance in the building, for instance, for how the products get in and out of the building, for how the needles are disposed of, all kinds of regulations that have to be put in place.

The reality is that the extra additional steps the law adds are not considerably greater than the steps that would have been undertaken anyway.

Having said that, we're delighted that now not only the Dr. Peter AIDS Centre but also Insite have been able to get their exemptions under the existing law. There are other communities that are currently working on getting an exemption under the existing law.

We will watch this very closely. We believe that it's not an unreasonable bar. We had indicated very clearly that Health Canada will support communities that want to work their way through this process. I will keep an open mind, but at this point we don't believe that it should be a top priority for us to amend that legislation because we believe that it looks like the municipalities are going to be able to work within it.

[The Chair, Liberal, Bill Casey]

Your time is up.

Dr. Eyolfson, you have seven minutes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

Thank you all again so much for coming. I've practised emergency medicine for 20 years and much of my subspecialty training involved toxicology and addictions. I also join Mr. Davies in congratulating you on your evidence-based approach to addiction and harm reduction.

This brings us to another very important addiction-related issue in Canada. According to your mandate letter, there are requirements for plain packaging of tobacco with regulations similar to Australia and the U.K. What progress has been made with that so far?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

That's a great question and again it speaks to the huge role of public health, and I'm really pleased to be able to support public health evidence-based approach to matters like tobacco control. You know Canada used to be seen as a world leader in tobacco control. Unfortunately in recent years many other countries have surpassed us and we are no longer necessarily seen as a world leader. It's time for us to get back onto the world stage in leading that.

You alluded to the fact that the mandate letter does include a number of measures including introduction of plain packaging. I think I'm allowed to tell you that we will be following the Australian model of plain packaging a little more. I'm very excited to say that all sorts of things happen in the background, but a lot of work is being done to get us to the point where we're going to, very soon, be able to take steps to introduce those measures and adjustments and regulations around plain packaging. Health Canada has been working a great deal on it, and we will be presenting the next steps in the very near future.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Okay, thank you.

Further to that, are you able to elaborate on any of these specific regulations that are inspired by Australia that we'll be adopting?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

I almost need my packages here to show you. A lot of it has to do with things like the colour of the packages, the text on the packages, the health messages. There are clever ways that companies are able to get around our current regulations, for instance, tucking advertising inside the packaging. The Australian approach is responding to all those different ways that advertising was able to bypass the mechanisms in the current approach. The reality is that there is a huge variance across the country so that a number of provinces have been quite proactive in introducing changes that would support better tobacco control. We hope to be able to provide a more uniform approach, and as I say, we probably will be a world leader in that matter.

Again, I would encourage you to get Simon to give you some more details on that. I don't know if you want to do that now or whether you'd like to wait until later.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

It doesn't matter. I think we'll take advantage of the time you have with us right now.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

These guys are getting bored, you see.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right.

Can you think of any specifics regarding Canada in our marketplace and culture that would differentiate it from places like Australia and the U.K., and that might cause differences in how we might regulate this?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

I'm not sure whether I can. Obviously we're a unique culture and there are challenges that Australia has faced as they've introduced their regulation that we will learn from. Australia, I believe, has had some legal challenges related to their introduction, and we'll learn from the lessons that Australia has undertaken in that regard to make sure that we manage those problems and try to avoid legal challenges as much as possible. But overall, they are seen as a world leader, and I think that we'll very much look to their example.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right.

Has the government or your department approached tobacco companies with this issue?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

I have not had conversations with tobacco companies about this, but I know the department has.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right.

There is also a lobbying group that is associated with convenience store owners who feel they have lost income due to the plain-wall provisions. Likewise, have those groups contacted the government yet regarding this issue?

[Simon Kennedy]

I'm not aware. It is possible. Certainly at my level we haven't met with that organization.

When we get to the regulatory process and get draft regulations, presumably a lot of these groups that have an interest would be wanting to make submissions and representations, but at this point I don't think we've had those kinds of detailed representations from some of the groups that you've mentioned.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Okay, thank you.

I still have some time. I think I've taken care of all the questions on that issue.

On an unrelated note, part of the mandate is to encourage the adoption of digital technology and electronic charting. There's quite a bit of disparity, not just from province to province but even within provinces and within different health regions.

Is a strategy being developed right now to level the playing field and make a consistent approach to electronic medical records?